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Mongbwalu is a town of about 50,000 people. A century ago, it was thick rain forest, but then in 1903 two Australians named Hannan and Orien, who were working in the Belgian colony, discovered gold. The indigenous peoples knew of the gold and made simple jewelry from it, but they were unaware of its value. Over time, the town boomed as a large scar was carved into the jungle for the sake of building mines and housing workers. Today, it looks like any other frontier town in Brazil or elsewhere. There is relatively little investment in infrastructure, public welfare and sanitation.
Mongbwalu is on the eastern edge of the Ituri Forest which is part of the Congo River basin.
This is home to 101 mammal species and 376 species of documented birds. The apex predator in the jungle near Mongbwalu is the leopard. The most common large mammal is the okapi, a brown smaller version of the giraffe with zebra stripes on its haunches. Also present are three variants of fruit bats, all capable of spreading the Zaire variant of Ebola. As development gradually destroys the rainforest, the concentration of miners, fruit bats, bushmeat hunters and virally infected mammals share and compete for the same disappearing space.
In Mongbwalu, where there is very limited refrigeration, ordinary people frequently depend on bushmeat for their protein. Farmers barely able to subsist on small plots of land set traps and snares to catch game, occasionally using crude or outdated weapons to bag a small antelope, monkey, or rat to mix in their stewpot. Bats are particularly valued because they are both plentiful and relatively easy to snag with a net if you know where they roost.
People who prepare or eat bushmeat in the Congo can contract monkeypox, HIV, anthrax, Q fever, Brucellosis, and, of course, Ebola.
How religion factors into the endemic
The indigenous peoples of the Congo originally practiced a native religion characterized by a belief in a supreme deity along with spiritism, animism, and a veneration of one’s ancestors. During the twentieth century, Protestant and Catholic missionaries began converting natives to Christianity, but the customs, and to an extent the teachings, of the old religion were slow to disappear. For example, when someone falls ill today, they often go to a healer who spends time with the sick person trying to discern the problem. He knows nothing about viruses, blood chemistry, infection control, and so forth. He believes that disease is generally caused by broken relationships involving jealousy, hate, or hostility. Or, perhaps some witch or sorcerer has cast a spell on the patient? Perhaps an evil spirit has possessed the sick person? Or, an ancestor has cursed him? The shaman (or Nganga as he is called) takes time to divine the problem and to perform the restoration ritual. If and when the patient dies, the family is charged with performing the funeral ritual that includes gathering and washing the body. If this sick person has Ebola, people are almost certainly infected during the process, starting with the Nganga and ending with the people who lower the deceased into the grave. Family members, friends, and visitors are all exposed to the virus.
What is known
The current ebola epidemic in Mongbwalu actually started 47 miles (75.7 km) away from Mongbwalu in Bunia, the capital of Ituri province. According to Médecins Sans Frontières (MSF) aka Doctors Without Borders:
The first confirmed patient to have Ebola Bundibugyo in this outbreak was one of four healthcare workers from Mongbwalu who went to the hospital in Bunia on April 24 with vague symptoms — initially fever, vomiting, and intense malaise. Hemorrhaging did not appear until the fifth day of infection. The hospital tested the patient for the Zaire strain, which came back negative. The patient died on May 5. That negative test is what set the catastrophe in motion — no one knew they were handling an Ebola corpse.
The body was transported back to Mongbwalu for burial. The tracker at ebola.fyi adds a harrowing physical detail: “the bumpy 80 km roads from Bunia to Mongbwalu cracked the coffin, exposing the corpse — meaning mourners and handlers were potentially exposed to infectious body fluids throughout the journey, before the funeral itself even began.”
At some point after leaving the clinic the family and friends decided that the coffin was not worthy to contain their deceased relative (perhaps because of the crack) and the relative was removed and placed in a second coffin. At that point if not earlier while being transfered to Mongbwalu, the virus escaped containment and infected a number of those bereaved.
Unaware that the patient had Ebola and that exposure to the body could make people sick, mourners thought the death was caused by a mystical illness and gathered for a funeral. Mourners in the region traditionally touch the dead as part of the grieving ritual. That physical contact with a highly infectious Ebola corpse, by an unknown number of people, in an enclosed space, is what ignited the Mongbwalu cluster.
The phantom coffin
On the streets of Mongbwalu, people are saying there is a phantom coffin moving through the community that brings instant death for anyone who sees it. According to community activists, this coffin is actually based on the cracked coffin that arrived from Bunia. From the perspective of the villagers, there was no ebola in Mongbwalu when the coffin arrived and afterwards (though not instantaneously, however as people believe) people started dying in their city. From this the residents concluded that this was a spiritual (i.e., supernatural) problem and people did not seek conventional treatment at the clinics. So, they are running to their Nganga rather than to the clinics. Misinformation filled the vacuum left by the diagnostic failure, and some residents began rejecting medical care in favor of prayer and traditional practices.
Iza Banga, a Congolese whose neighbor died in the outbreak, described the community’s shift from rumor to dread:
At first, we believed rumors saying there were coffins that killed people. But now we see that people are dying almost every day here in our neighborhood. We are really afraid for our lives, and we want the authorities to find a solution.
It gets worse
Two weeks ago, a WHO affiliated clinic run by MSF treating ebola patients in Ituri was burned to the ground because the clinic would not turn over the body of a deceased ebola victim. It is after death that the infected person has the greatest chance to infect others. Several days ago, another MSF clinic was burned and 18 suspected Ebola patients fled into the community and are now unaccounted for. A third attack involving gunfire occurred last Sunday (May 24th). Acting violently on these beliefs do not help local authorities contain the virus.
And worse
Since the beginning of the present administration in Washington, foreign aid used for a number of purposes — including procuring medical supplies to fight infectious outbreaks such as Ebola — has been cut by 57%. Additionally, the U.S. ended funding to the World Health Organization which the Congo depends on for disease control. The lack of funding caused one major non-governmental organization (NGO), the International Rescue Committee, to withdraw from three of its five health zones in Congo, all of which are in Ituri Province — the current epicenter of the outbreak. So, the lack of foresight could come back to haunt Americans, even as the diminished Centers for Disease Control and Prevention and epidemiologists across the U.S. eye the Congo nervously.
Readers who want specific details on the cutbacks and cosequences can find them here, and here; here, here and here and here.
And . . . worse
Unlike other Ebola variants, this one (Bundibugyo ebolavirus (BDBV) has no effective pharmaceutical treatment. It may be because it is so rarwely encountered. The most that can be offered is supportive care, assuming aick patients report to the treatment center for help and the treatment center is not burned to the ground by the villagers.
How Ebola spreads in the Congo
As of May 24th, patient zero had not yet been identified. Unless and until the medical authorities do, they cannot determine how the infection began. However, what follows are the more common ways.
Perhaps the most common way Ebola spreads is through bats. Infected bats can bite or scratch people — including children. A bushmeat hunter might accidentally cut himself while preparing bat meat. Or there can be an intermediate host. Ebola can infect and kill antelopes, chimpanzees and apes. The mortality rate among gorillas from Ebola is higher than the rate in humans.
Once a person has it, they can spread it to others through blood, saliva, sweat, tears, mucus, vomit, feces, breast milk, urine, and semen. A person can contract it from objects such as linen or hospital equipment which act as fomites. It can spread through sexual intercourse, but not from simply passing someone who has it, assuming there is no contact. Nor does it generally spread through respiratory means, though if it has aerosolized, it might be present if someone close to you with Ebola coughs or sneezes. Mostly it is spread through secretions and physical contact.
The R (reproductive) value of the Bundibugyo ebolavirus (BDBV) variant that is currently spreading has not yet been computed. It is estimated to be between 1.5 and 2.5, which means that each infected person transmits to between one and two other people, though medical personnel on the ground think it is probably higher than that. As a comparison, the R value for measles in the U.S. is R12–R18, which means that a sick person, usually a child, can spread it to a dozen or more others. In fact, an infectious child with measles can ride an elevator, and a few minutes later another person can enter the elevator and catch it from the sick, and presumably unmasked, child who left the elevator a few minutes earlier. The Omicron BA.1 strain of COVID had an R value of approximately 9. If the R value is less than one, the virus is burning itself out. With Ebola, however, the R value is not necessarily determined by the virus itself, but by the response of the community to the virus. If the community does not heed medical advice, then the R value rises when all other things considered are equal, it should not.
When a person is exposed to the virus, there is an incubation period that is usually four to ten days, though it could be as few as two days and as many as three weeks. Fortunately, during the incubation period, the patient is not infectious. Once they start to show signs of infection, the ability of the sick person to spread the disease sharply rises, and is worst after the patient actually dies, as mentioned earlier.
Signs and symptoms of BDBV include fever, found in 87% of patients; fatigue (76%), vomiting (68%), diarrhea (66%), and loss of appetite (65%) follow, or are noted, during presentation. Muscle pain and headache are also present in Ebola patients, but these same symptoms are also found in other diseases endemic to the Congo, such as cholera, malaria, and typhoid. Gastrointestinal problems such as nausea, vomiting, and diarrhea, and respiratory symptoms, soon follow.
At some point, the patient with Ebola starts to bleed. They suffer nosebleeds, vomit blood, experience blood in their stools, and show signs of clotting problems. Unseen damage is occurring to their liver, kidneys, and other vital organs, and the loss of fluids causes electrolyte imbalances. During the final hours, the patient may be unconscious, delirious, or disoriented. Their blood pressure crashes and they die, commonly of multiorgan failure.
The domestic response
Until 2014, the U.S. had only three Tier One hospitals with a total of 25 beds. These facilities are built for such cases from the ground up. You can’t simply have a standalone wing in a regular hospital for patients with viral hemorrhagic diseases such as Ebola. How do you get these patients to other hospital resources? You can’t push them down the hallways. These units feature negative airflow, HEPA filtration, and specialized PPE protocols — all of which demand regular training.
After two nurses in the U.S. contracted Ebola from an infected Liberian patient who arrived in Dallas, Texas, the CDC scrambled to designate a second tier of less specialized but Ebola-ready facilities. According to the CDC, before President Barack Obama left office in 2017, the U.S. had a network of 51 Ebola Treatment Centers in 16 states and Washington D.C., with 72 available beds. A 2015 survey of those facilities found a total simultaneous capacity across 47 responding centers of 121 beds.
That is an improvement, but nowhere near sufficient. Meanwhile, U.S. international airports have dusted off their protocols to screen arriving travelers.
Current as of 26 May 2026
#Ebola
#Congo
One Response
This is both informative and great storytelling. Thank you.